Q. I have a problem with bowel movements. Kindly help me.

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Feb 15, 2018 and last reviewed on: Oct 09, 2018

Hello doctor,

I am having a problem with bowel movements with soft, pasty stools. Lots of small stools after the first bowel movement in the morning. All bowel movements take hours to develop once I feel I am in need of a bowel movement. Often times I have to manipulate bowel movement with a shallow enema. Most bowel movements are difficult and are a single push that leaves me feeling as it is incomplete. The build up to a movement either assisted or not is extremely uncomfortable. No sharp pains but gassy, bloated and a feeling of inflammation in lower bowel where sigmoid colon meets rectum. I have no problem with fiber in my diet and I eat fermented foods and take probiotics.



Welcome to icliniq.com.

So, this basically occurs due to constipation and incomplete evacuation. There are certain points you need to remember.

Firstly, you need to have a healthy lifestyle which includes a healthy diet and regular exercises.

In diet, you should eat a high-fiber diet like fruits (apple, banana, oranges), green leafy vegetables like spinach, raw cucumber, whole wheat, etc., and plenty of water, which will help your free passage of stools.

Next thing, make use of morning gastrocolic reflex. Normally when one eats breakfast, one tends to get a bowel movement. So have a good breakfast and plenty of water which will give good gastrocolic reflex. Visit washroom after this reflex comes.

Most importantly, effective and physiological treatment is fiber supplementation. You should have Psyllium husk 5 to 6 g with each meal and drink plenty of water after it so as to give good volume to your stools. Gradually, we can increase the dose as needed up to 10 g with each meal.

If this is not effective we can try other laxatives like syrup Lactulose 15 to begin with and increased up to 30 ml at bedtime which is also quite effective. Linzess you have already been trying, Lubiprostone we can try later. But we try to avoid this as much as possible as it can lead to laxative abuse.

Hope this helps you and get back if you have any doubts.

For more information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

Thank you doctor,

My diet is alright on fiber from fruits, flax seed meal, gluten-free rice bread, raw tomatoes, and spinach. I have crunched the numbers enough to know I get more than the recommended amount. I exercise daily unless the discomfort of feeling constipated or needing a bowel movement keeps me from it. Even then, I try to stay moving or at least standing. My diet is gluten-free, mostly non-GMO, organic, and healthy in any way. My best guess from symptoms is that it could be a rectal prolapse and/or my bowels just do not move well enough on the lower end. All of the difficulty comes in the junction of the sigmoid colon and the rectum. Would it be better to talk to a doctor of gastroenterology?



Welcome back to icliniq.com.

Yes, certainly it would be better if you direct your query to gastro side.

But, as far as rectal prolapse is concerned, you would have noticed some mass protruding per anum. While if there is no direct prolapse of mass, will need defecography via fluoroscopy or MRI to confirm the diagnosis. Also, as much as 75 percent patients also get incontinence episodes in rectal prolapse, I guess you did not have any.

So, I think, good examination followed by investigations will help in confirmation of diagnosis in your case. Gastroenterologist frequently does colonoscopy also as a part of screening in elders. And in such cases, the role of medical management is limited and mostly needs surgery. So I think, an in-person visit to a gastroenterologist would be more fruitful as the diagnosis is mainly based on examination.

All the best.

For more information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

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